A typically cheery view by Eric Topol, MD of what medical practice will look like after COVID is over. With the full court press to go remote in hospitals and practices worldwide, telehealth and telemedicine has gone fast forward in a matter of under two months. But what will it look like after it’s over? Most of what the good doctor is prognosticating will be familiar to our Readers who’ve followed him for years–certainly he was right on mobile health overall and especially AliveCor/Kardia Mobile— but not so on point with mobile body scanners (anyone remember VScan?)

When the high tide recedes, what will the beach look like?

“Telemedicine will play the role of the first consultation, akin to the house-call of yore.” (Terminology note–interesting that Dr. T still uses ‘telemedicine’ versus ‘telehealth’–Ed.)

Chatbots will serve as screeners–once they are proven to be effective (a ways to go here, as the Babylon debate rages on)

Smartphones will be the hub, connecting with all sorts of monitoring devices (the ‘connected health’ Tyto Care and Vivify Health model–which makes the Editor’s former company, the late Viterion Digital Health, even more of a pioneer that died crossing the Donner Pass of 2016)

Smartwatches are also part of this hub (this Editor remains a skeptic)

Now is the time to harness technology by both health systems and individual practices, but multiple barriers remain. (This Editor can speak to the difficulties for both primary care and specialty practices in not only practice but also reimbursement–and acceptance by patients.) Device expense is also a problem for the non-affluent.

As to the rest, it is pretty much what we’ve heard from Dr. T before. The Economist

Your Editor will add:

Easy to use, secure platforms that don’t put users through multiple security steps remain a concern for users. This Editor’s concern is that easy to use = insecure. Skype and Zoom are inherently insecure–Skype’s user unfriendliness and insecurity outside enterprise platforms and Zoom’s major security problems on its platform and user flaws are well-known (ZDNet).

Reimbursement, again! CMS has done a creditable job in broadening reimbursement for telehealth a/v and telephonic services, but coding remains a nightmare for practices struggling to remain open and with some lights on. After COVID, will CMS and HHS get religion, or put it right back in its rural bottle? Covered in the CARES Act passed at the close of March, $200 million sounds like a lot from the FCC to bankroll telecom equipment for providers, but these funds will go quickly. At least they are not delayed in endless rule making, as the Connected Care Pilot Program has been for two years. Mobihealthnews

Tunstall Healthcare announced on Wednesday that they have secured additional funding from Barings, M&G, and an unnamed lender group for growth. The funding amount was not disclosed.

The release is unusually terse in that the funding round, while the lead, is only briefly mentioned in the actual release at the beginning and end. What the funding will support is generic, which is not atypical: “a significant commitment from Tunstall’s lenders and will provide the Company with flexibility and improve the overall financial strength of the business” and that the funding will go towards developing new systems.

Perhaps clues to their future, or past, are here. An anonymous source advised this Editor to take a closer look at a company called TGH Acquisitions Limited. Their report on Companies House indicates that indeed it is a financing arm of Tunstall Healthcare Group with its last report for the year ending 30 Sept 2018–and showing an after-tax profit of over £75 million. Unfortunately, the parent company Tunstall Healthcare Group in the same period showed a consolidated loss of over £284 million. The good news in that red ink is that the loss was reduced by over £100 million. The report to 30 Sept 2019, which should have come out in mid-February, is not on Companies House.

Tunstall Healthcare remains a major global company in the telecare and remote monitoring field, with operations in 17 countries. In January 2019, they sold their US operation to Connect America, exiting the hyper-competitive US market [TTA 29 Jan 19]. Recently, they entered the complex care management (CCM, often called chronic care management) and transitional care management (TCM) fields.

Given the global spotlight on telehealth during the COVID-19 pandemic, the funding may be just in time to ‘catch a wave’, as they say on the Jersey Shore.

It also appears from the website and a quick check on LinkedIn that some of the leadership, such as Marcus Grindstaff, the former COO, has been retained by PRA. And yes, they are still marketing QuietCare (developed by Living Independently Group, this Editor’s employer some years ago).

In recent years, CROs have used remote monitoring as part of clinical drug trials, but this may be the first purchase. PRA’s relationship with Care Innovations dates back to 2017 with a strategic partnership for clinical trials.

The latest iteration of Care Innovations’ Health Harmony is as a turnkey remote monitoring system for COVID-19, to be deployed by employers, payers, providers and health systems to track individuals who may be asymptomatic, exposed or diagnosed with coronavirus. It is designed in three stages: education, quarantine, and in-depth monitoring/care coordination with a healthcare professional. Patients report on a tablet or smartphone vitals such as temperature, heart rate, pulse oximetry and COVID-19 symptoms like shortness of breath, fatigue, and changes in coughing. This information uploads to a dashboard monitored by a clinical call center. ReleaseHat tip to reader Paul Costello

Tyto Care today (7 April) announced a venture round investment of $50 million by Insight Partners, Olive Tree Ventures, and Qualcomm Ventures LLC plus previous investors. The new investment will pay for commercialization throughout the US, Europe, and Asia as well as to introduce new advanced product capabilities including AI and machine learning-based home diagnostics solutions and other patented technologies.

Tyto’s timing could not be better for the raise. In the US, led by CMS with private payers following in near lockstep, the past month has seen the rapid unrestricting of payment for telehealth services like virtual visits of the audio-visual type and short asynchronous and synchronous image and audio/telephonic short visits. Tyto’s remote medical exams of the lungs, heart, throat, ears, abdomen, and body temperature fits into the current and likely future need. Both live exams and asynchronous forwarding of data are part of a platform that integrates with EHRs and third party exam tools.

Tyto Care works with hundreds of hospitals and over 100 health organizations including health systems, payers and strategic partners, primarily in North America, Europe, and Israel. In 2019, they had over 200,000 examinations.

If, like your Editor, you believe that the tidal wave of telehealth has changed the office visit model for keeps, adding remote diagnostics can be a winner–if Tyto can navigate the tricky shoals of a largely consumer-based marketing strategy (Best Buy) and gain adoption by health systems and payers, as they have in Israel with Sheba Medical Center [TTA 28 Feb]. Release, FierceHealthcare

Even the ‘Bad Blood’ trial has a Coronavirus Twist. The trial of Theranos former CEO Elizabeth Holmes surfaced last week in the midst of the Public Health Emergency in the US District Court in San Jose, where Holmes is scheduled to go on trial in August. Williams & Connolly lead attorney Lance A. Wade filed a motion with Federal Judge Edward Davila to permit Holmes’ attorneys to travel, serve subpoenas and meet with potential witnesses, which would include health care professionals and testing laboratories, all in preparation for the trial. Judge Davila basically swatted it aside, stating “I have to tell you sir, I read [the document] and I was a little concerned,” the judge said. “You’re basically filing a motion in essence asking the court to violate orders in the midst of a national crisis.” Wade stated that it would be nearly impossible to prepare Holmes’ defense without violating shelter-in-place orders and public health warnings. While both the judge and the lead counsel agreed that much could be done remotely to prepare for trial, Wade maintained that it would be ‘almost impossible’ to complete it.

The trial date may change at the next hearing on 15 April, since the judge has requested both the prosecution and defense to propose alternative trial schedules. Jury selection is scheduled to start in late July.

A prosecutorial deteriorata? In February, the nine counts of wire fraud and two counts of conspiracy were reduced by the judge, who dismissed the two conspiracy charges related to defrauding patients and directing doctors to misrepresent Theranos to patients. He also severed Holmes’ trial from former president and live-in Sunny Balwani’s. One wonders that, between the reduction of charges and the delay which has made The Biggest Healthcare Fraud of the 21st Century old news, whether Holmes and Balwani will serve any significant Club Fed time at all. Law360.CNBC, Observer

Another Corona Twist is that aSoftBank/Fortress Investment shell company, Labrador Diagnostics LLC, which happens to own several Theranos patents, sued a small company, BioFire, developing COVID-19 tests. Labrador now states that the patent infringement doesn’t entail the COVID tests but others over the past six years. Our Readers will recall that SoftBank/Fortress was a ‘last ditch’ investor in Theranos in December 2017, collateralized by the patent portfolio. The Verge

Keeping calm and carrying on (but taking precautions, staying inside, and keyboarding with hands that resemble gator hide), yes, there IS some news that isn’t entirely about COVID-19:

This Editor had put aside the $70 million funding by the UK’s Cera at end of February. What is interesting is that Cera Care is a hybrid–specializing in both supplying home-based care, including dementia care, and providing tech-enabled services for older adults. The funding announcement was timed with the intro of SmartCare, a sensor-based analytics platform that uses machine learning and data analytics on recorded behaviors to personalize care and detect health risks with a reported 93 percent accuracy. It then can advise carers and family members about a plan of action. This sounds all so familiar as Living Independently’s QuietCare also did much the same–in 2006, but without the smartphone app and in the Ur-era of machine learning (what we called algorithms back then).

The major raise supports a few major opportunities: 50 public sector contracts with local authorities and NHS, the rollout of SmartCare, its operations in England and Wales, and some home healthcare acquisitions. Leading the round was KairosHQ, a US-based startup builder, along with investors Yabeo, Guinness Asset Management, and a New York family office. Could a US acquisition be up next? Mobihealthnews, TechEU

Located on NYC’s Great Blank Way (a/k/a Broadway), Rx.Healthhas developed what they call digital navigation programs in a SaaS platform that connect various programs and feed information into EHRs. The interestingly named RxStitch engine uses text messages (Next Gen Reminder and Activation Program) or patient portals to support episodes of care (EOC), surgeries, transitions of care (TOC), increasing access to care, telehealth, and closure of care gaps. Their most recent partnership is with Valley Health in northern NJ. Of course they’ve pitched this for COVID-19 as the COVereD initiative that supports education, triage, telehealth, and home-based surveillance as part of the workflow. Rx.Health’s execs include quite a few active for years in the NY digital health scene, including Ashish Atreja, MD.

Teledentistry to the rescue! Last summer, we focused on what this Editor thought was the first real effort to use telemedicine in dentistry, The TeleDentists can support dentists who are largely closing shop for health reasons to communicate with their own patients for follow up visits, screen new patients, e-prescribe, and refer those who are feeling sick to other telehealth providers. For the next six weeks, patients pay only $49 a visit. More information in their release.Hat tip to Howard Reis.

What actions are smaller telehealth companies taking now? Reader and commenter Adrian Scaife writes from Alcuris about how their assistive technology responds to the need to keep in touch with older people living alone at home. Last week their preparations started with giving their customers the option to switch to audio/video conferencing with their market teams. This week, they reviewed how their assistive technology and ADL monitoring can keep older people safe in their homes where they may have to be alone, especially after discharge, yet families and caregivers can keep tabs on them based on activity data. A smart way for a small company to respond to the biggest healthcare challenge of the last 30 years. Release.

Even Caravan Health, a management services company for groups of physicians or health systems organizing as accountable care organizations (ACOs) in value-based care programs, is getting into digital health with their purchase of Wellpepper. The eight-year-old company based in Seattle works with health plans to provide members with outpatient digital treatment plans, messaging services, and an alert system to boost communication between care teams and patients. Purchase price was not disclosed, but Wellpepper had raised only $1.2 million in debt financing back in 2016 so one assumes they largely bootstrapped. Mobihealthnews

Practically all events that this Editor has noted on the calendar for the next few months have been converted to virtual events or postponed due to emergency restrictions around COVID-19.

Close to our Editors’ hearts is DHACA Day–a must-read update. Originally set for tomorrow 18 March, it is now planned as a virtual event on Wednesday the 25th starting at 10am. Editor Charles Lowe has an update on the DHACA website in his mid-March newsletter. The tentative theme is ‘The silver lining in the COVID-19 cloud’.

Charles is also compiling a list of “all the products that members make and services that members provide that will help the health services and patients cope with Covid.19 and the subsequent lockdown.” There are more ‘calls for assistance’ in the newsletter for everything from ventilators to technical help at Public Health England.

HITLABis going virtual indefinitely. Dr. Stan Kachnowski’s emailed update todaynotes that the Women’s Health Tech Challenge on 16 April is on as a virtual event, and virtually free. Remaining Seminar Series events will be virtual–and these extend into August. This Thursday’s (19 March) seminar will be a virtual town hall to discuss digital solutions which can help patients and physicians in the age of the coronavirus, with an international cast–panelists from Scripps Translational Institute, Ugandan Health, and more. Registration here (free).

UPDATE: The sole outlier up until mid-week was the American Telemedicine Association’s ATA 2020 that was going to be in Phoenix 3-5 May. It won’t be a cure for cabin fever in the sun, as ATA’s announcement of a 100 percent virtual conference is up here. Details to come.

Today (17 March), the Center for Medicare and Medicaid Services (CMS) issued a Fact Sheet and FAQs explaining how the expanded telehealth provisions under the Coronavirus Preparedness and Response Supplemental Appropriations Act and the temporary 1135 waiver will work. The main change is to (again) temporarily expand real-time audio/video telehealth consults in all areas of the country and in all settings. The intent is to maintain routine care of beneficiaries (patients), curb community spread of the virus through travel and in offices, limit spread to healthcare providers, and to keep vulnerable beneficiaries, or those with mild symptoms, at home. Usage is not limited to those who suspect or already are ill with COVID-19.

Previously, only practices in designated rural health areas were eligible for telehealth services, in addition to designated medical facilities (physician office, skilled nursing facility, hospital) where a patient would be furnished with a virtual visit.

The key features of the 1135 telehealth waiver are (starting 6 March):

Interactive, real-time audio/video consults between the provider’s location (termed a ‘distant site’) anywhere in the US and the beneficiary (patient) at home will now be reimbursed. The patient will not be required to go to a designated medical facility.

Providers include physicians and certain non-physician practitioners such as nurse practitioners, physician assistants and certified nurse-midwives. Other providers such as licensed clinical social workers (LCSW) and nutritionists may furnish services within their scope of practice and consistent with Medicare benefit rules.

Surprisingly, there is ‘enforcement discretion’ on the requirement existing in the waiver that there be a prior relationship with the provider. CMS will not audit for claims during the emergency. (FAQ #7)

Even more surprisingly, the requirement that the audio/visual platform be HIPAA-compliant, as enforced by the HHS Office of Civil Rights (OCR), is also being waived for the duration (enforcement discretion again), which enables providers to use Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype–but not public-facing platforms such as Facebook Live, Twitch, or TikTok. Telephones may be used as explicitly stated in the waiver in Section 1135(b) of the Social Security Act. (FAQ #8) More information on HHS’ emergency preparedness page and OCR’s Notification of Enforcement Discretion.

On reimbursement, “Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.”

Concerns for primary care practices of course are readiness for real-time audio/video consults, largely addressed by permitting telephones to be used, as well as Skype and FaceTime, and what services (routine care and COVID-19 diagnosis) will be offered to patients.

This significant expansion will remain in place until the end of the emergency (PHE) as determined by the Secretary of HHS.

In 2019, CMS also expanded telehealth in certain areas, such as Virtual Check-Ins, which are short (5-10 minute) patient-initiated communications with a healthcare practitioner which can be by phone or video/image exchange by the patient. This could be ideal for wound care where this Editor has observed, in one of her former companies, how old phones are utilized to send wound images to practices for an accurate ongoing evaluation via special software. E-Visits use online patient portals for asynchronous, non-face-to-face communications, initiated by the patient. These both require an established physician-patient relationship. Further details on both of these are in the Fact Sheet, the FAQs, and the HHS Emergency Preparedness page with links.

France’s Kompaï assistance robot is finally for sale to health organizations, primarily nursing homes and hospitals. Its objective, according to its announcement release, is to help health professionals in repetitive daily tasks, and to help patients. It’s interesting that the discussion of appearance was to achieve a ‘slightly humanoid’ look, but not too human. The development process took over 10 years. (Here at TTA, Steve’s first ‘in person’ with the developers was in May 2011!) Kompaï usage mentioned is in mobility assistance and facility ‘tours’ and public guidance. Here’s Kompai in action on what looks like a tour. Press release (French/English)

The older adult tech market has been recognized as an opportunity by such companies as Best Buy, Samsung, and Amazon. Medicare Advantage payers now cover some tech.

Advances plus smart marketing in hearing tech–one of the top needs in even younger demographics–is disrupting a formerly staid (and expensive)

The White House report “Emerging Technologies to Support an Aging Population” [TTA 7 March] first was an acknowledgment of its importance and two, would also serve as a great source document for entrepreneurs and developers.

The study covers the demographics of the older adult market, where they are living, caregiving, the effect of data breaches, optimizing design for this market, the impacts of voice-driven assistants, wearables, and hearables.

Project Nightingale may be singing to some US Senators. The 10 million Ascension Health identified patient records that were transferred in a BAA deal to Google [TTA 14 Nov 19], intended to build a search engine for Ascension’s EHR, continue to be looked into. They went to Google without patient or physician consent or knowledge, with major questions around its security and who had access to the data. A bipartisan group of senators is (finally) looking at this ‘maybe breach’, according to Becker’s. (Also WSJ, paywalled)

Your Editor has been offline since Monday to this afternoon (EDT) due to a Fios network outage, not a health outage due to COVID-19. Since last week and the HIMSS20 cancellation, major conference and meeting cancellations and reschedulings are multiplying like fig buttercups in the spring. And yes, WHO has declared it a pandemic as Italy closes down and the US bans travel and even trade from Europe for the next 30 days, but not the UK. (There are additional relief measures including a requested payroll tax reduction, tax deferrals and assistance to small businesses. Many schools and businesses are going remote and long-term care residences, a nexus of infection, are being strongly encouraged to defer non-medically necessary visitors.)

Below are some of the majors and of interest to Readers in the digital health area. Most are the largest conferences with international attendees:

Naidex and its eight co-located conferences in Birmingham 17-18 March are postponed until later in the year. The exact date will be revealed on Monday 16 March. Additional information. Hat tip to Adrian Scaife in Comments

The NAACOS (National Association of Accountable Care Organizations) conference in Baltimore 1-3 April as of 10 March is ‘evaluating its options’ and will notify registered attendees by email. (Providers in ACOs increasingly use telehealth for their patients as CMS and the states have broadened reimbursement.)

Running lists are up at Forbes (including sporting events such as the NBA, Broadway, and every major St Patrick’s Day parade; happily the NY International Auto Show is moved to 28 August) and MedPage Today. Healthcare IT News has a list of government and academic information resources led by the CDC, the WHO, and the NHS. We’ll repeat the NHS pages from our earlier article:

The UK Department of Health and Social Care and Public Health England has provided the following links to coronavirus guidance (hat tip to DOHSC via LinkedIn):

The House of Representatives, which controls appropriations, has passed H.R. 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act. The bill provides $8.3 billion in new funding that includes a significant telehealth waiver for Medicare. From the bill summary on Congress.gov:

Within the Department of Health and Human Services (HHS), the bill provides FY2020 supplemental appropriations for

the Food and Drug Administration,the Centers for Diseases Control and Prevention,the National Institutes of Health, andthe Public Health and Social Services Emergency Fund.

In addition, the bill provides supplemental appropriations for

the Small Business Administration,the Department of State, andthe U.S. Agency for International Development

The supplemental appropriations are designated as emergency spending, which is exempt from discretionary spending limits.

The programs funded by the bill address issues such as

developing, manufacturing, and procuring vaccines and other medical supplies;grants for state, local, and tribal public health agencies and organizations;loans for affected small businesses;evacuations and emergency preparedness activities at U.S. embassies and other State Department facilities; andhumanitarian assistance and support for health systems in the affected countries.

The bill also allows HHS to temporarily waive certain Medicare restrictions and requirements regarding telehealth services during the coronavirus public health emergency.

Sponsored by retiring Rep. Nita Lowey (D-NY), it was introduced and passed in the House 415-2.

In the text of the bill, the telehealth-pertinent portion permitting CMS to waive restrictions on telehealth for Medicare beneficiaries during this emergency is Division B, Sections 101-102. This cost is estimated at $500 million by The Hill.

The bill went to the Senate yesterday (4 Mar) for final approval. There is already an amendment proposed by Senator Rand Paul (R-KY) to offset the $8 bn of the bill with unobligated, non-health related foreign aid funds (FreedomWorks). Whether this is the ‘offset’ for telehealth that is mentioned in The Hill as under negotiation is not revealed.

The American Telemedicine Association (ATA) approved of the waiver. Ann Mond Johnson, the ATA’s CEO, urged “CMS to implement its waiver authority as soon as possible to ensure health care providers understand any requirements and help speed the deployment of virtual services” and pledged “The ATA and its members will continue to work with federal and state authorities, including HHS and the CDC, to address the COVID-19 outbreak and ensure resources are appropriately deployed for those individuals in need of care and help keep health care workers safe.” ATA press release, Hat tip to Gina Cella for the ATA heads-up

The advisory panel recognized that industry understanding of the potential reach of the virus has changed significantly in the last 24 hours, which has made it impossible to accurately assess risk. Additionally, there are concerns about disproportionate risk to the healthcare system given the unique medical profile of Global Conference attendees and the consequences of potentially displacing healthcare workers during a critical time, as well as stressing the local health systems were there to be an adverse event.

Also from the announcement: “HIMSS20 exhibitors and attendees will be contacted with further information regarding booth contracts and registrations. Please contact exhibitors@himss.org for immediate booth concerns.”

The CHIME (College of Healthcare Information Management Executives)/HIMSS CIO Forum symposium on Sunday 8th-Monday 9th is also canceled, per a comment on HISTalk. The only indicator on their website as of now is a large ‘CANCELLED’ on their event list. Later this month is the 5G Executive Forum on 25-26 March in Plano, Texas; is that now being reevaluated?

Neither will be rescheduled for this year. Further chatter on the 3/6 HISTalkcenters on what to do with all the promotional items and after-action assessments of losses to marketing and sales. There are companies which center their annual budget and marketing efforts on HIMSS, perhaps not the best ‘eggs in one basket’ strategy, but one that many follow. Hat tip to HISTalk and their ace staff

For our UK and European Readers, Naidex is one of the largest conferences for independent living and healthcare. So far, it is on at Birmingham NEC from 17–18 March, they are taking a long list of precautions based on guidelines set by the WHO and local authorities, but according to their site statement by the event director, it is a fast-moving situation and may change based on those advisories. POSTPONED 10 March–see 12 March update.

Original article follows:

There is a growing list of exhibitor and attendee cancellations for HIMSS20 in Orlando, Florida, starting next Monday the 9th. HIMSS is one of the largest global healthcare conferences, and is a ‘must attend’ for a wide swath of healthcare-related companies, including clinical and monitoring technologies, software from the giants (Microsoft, Cisco) to the startups, hospital systems, payers, telecoms, and all sorts of governmental entities like CMS. (When the opening keynote speaker is President Trump, you know it’s important.)

Based on the comments and HIMSS’ own advisory, HIMSS is accepting cancellations from the CDC’s Level 3 or 4 alert countries, but other cancellations are not being refunded (likely pushed to 2021). Hotels/airlines may not be refundable based upon policies and the clout of travel bookers. Onsite, HIMSS is preparing onsite medical offices for care and screening, as well as promoting the HIMSS elbow bump in lieu of the handshake. It’s regrettable as there are hundreds of staff involved year to year who are responsible for all the planning, marketing, logistics, and security for HIMSS and any conference of this size.

The major reason? Many companies, including healthcare companies, have indefinitely canceled non-essential travel across the board for the next 30 to 60 days as a matter of institutional policy. The large destination conferences taking place March-June are the most affected by this. Consider that for the immunocompromised, attending any large conference is dicey, but COVID-19 is one large red flag.

IBM has canceled Think 2020 in May, which regularly attracts 30,000 attendees to San Francisco. Mobile World Congress Barcelona, the largest in the telecom sector which crosses over to mobile-based healthcare, canceled two weeks before starting on 24 February. The American Physical Society (physics) canceled this week’s conference in Denver the day before it started. The LA Times has a roll call of canceled conferences including Facebook and Google I/O. Others remain on, but monitoring the situation: the American College of Healthcare Executives Congress on 23 March and EPIC 2020 in Croatia 19-21 March [TTA 16 Jan].

HISTalk’s 5 March article (scroll down) reports on the findings from the leader of the WHO team which spent two weeks in China studying their COVID-19 response. China is moving patients from their best hospitals to ‘routine care’ to accommodate COVID-19 patients. Children do not seem to become infected or be carriers. The trend in infection there is trending down. Overall, it seems to be a series of global outbreaks, not a global pandemic. And they came away with a fatality rate in China of 1-2 percent, which seems low based on other reports.

Coronavirus (COVID-19), which originated in Wuhan, China and has spread to at least 40 countries and 80,000 victims, with 2,700 fatalities, has been roiling both financial and healthcare markets. The stock price of payers in the US have been hit hard due to an anticipated uptick in illness, but interestingly, Teladoc has been up quite smartly in the past few days. Teladoc reported that one of eight virtual visits in January was due to flu, which isn’t atypical–but half had not used Teladoc before. Analysts do expect that there’s an opportunity for telehealth and telemedicine providers to attract new users due to what this Editor has dubbed ‘conscious contact’–that if you even feel remotely sick, you’re going to turn to a virtual visit.

COVID-19 is not remotely near a pandemic outside of China. The three hallmarks of a pandemic are cross-seasonal outbreaks (so far only in China), cross-geography (done), and most importantly, attacking the well. The fatalities have been among those with compromised immune systems, not among the young and healthy who do get it. It’s alarming, like SARS, because of the origination in animals, and the ease of person-to-person transmission via travel, as the outbreaks in Iran, South Korea, Italy, and on cruise ships visiting Asia have confirmed. In the US, the CDC is reporting that it is not currently spreading in the community, but is preparing for that scenario including containment, and has been since January.

But beyond the virtual visit, there are other areas where digital health is part of dealing with COVID-19:

Preventing the spread to the patient’s family members. Avaya has been working in China since January to provide enterprise customers with home agents to prevent the spread of the virus. For hospitals, they have donated equipment to enable remote consultation services and remote visiting video at the hospitals, including observation of isolation wards. They have provided a case study of their work with the Tongxiang Hospital at the Tongxiang Branch of Zhejiang Province People’s Hospital. (Photo at left courtesy of Avaya.)

Another is remotepatientmonitoring. Sheba Medical Center in Tel Hashomer, Israel, is using Tyto Care to monitor the 12 Israeli returnees from the Diamond Princess cruise ship, who continue to be in isolation. The patients will perform the tests on themselves, especially respiratory tests. Jerusalem Post

Update 2 Mar:A representative from Sheba, the largest hospital system in the Middle East, was kind enough to contact me with additional information on their RPM program for COVID-19. For patients requiring isolation in that stage of treatment, Sheba has implemented a modular ‘field hospital’ setup, similar to what the Israeli (and US) military use, which can be set up in any open area. This isolation is to protect immunosuppressed patients from disease spread in the main hospitals. Telehealth being used in addition to Tyto are the Vici telemedicine robot and the Datos Health app for home treated patients. This Editor believes that both European and US public health systems are looking at the Sheba and Israeli approach.

Robots–actually a telehealth cart–are being tested for patient self-testing, much like Tyto Care’s use at Sheba. Robots could also deliver food (although they could also carry germs) and sweep streets.

Other monitoring can be done via symptom checkers (Babylon, K, and others). 98point6 released a coronavirus screening chatbot app as early as January, but what they’ve turned up so far is more cases of the flu. STAT

Data analytics can pinpoint outbreaks. The Epic, Athenahealth, and Meditech EHRs have released new guidance, testing orders and screening questions (e.g. around travel and contacts) that will help to identify outbreaks.

Update 28 Feb: This Editor would like to know more about UV disinfection being used versus coronavirus for large spaces such as in hospitals and aircraft. If you have information on technologies such as PurpleSun which have been tested against hospital pathogens also being used against coronavirus, please contact Editor Donna.

Healthcare technologies which weren’t around during the SARS and swine flu epidemics may make a big difference in the spread, treatment and mortality rate of COVID-19. Healthcare Dive,HealthTechMagazine

UPDATE 28 FEB

As a service to our Readers, we are providing the following health service update links:

The UK Department of Health and Social Care and Public Health England has provided the following links to coronavirus guidance (hat tip to DOHSC via LinkedIn):

While we’re on the subject of symptom checkers (Babylon Health below), K Health, a competitor in the US HQ’d in NYC, but also based in Tel Aviv, announced today their win of $48 million in a Series C funding round, led by 14W and Mangrove Capital Partners. Lerer Hippeau, Anthem (also a partner), Primary Ventures, and others participated. Their total funding is $97 million since November 2016. The new funding, according to Crunchbase News, will be used to scale the model, expand primary care to mobile devices, and expand to international markets.

K (as they call themselves) concentrates on three areas. One is an AI-powered symptom checker that uses millions (they state) of anonymized medical records to provide a virtual consult. According to Crunchbase, the medical records came from Israel’s second-largest HMO, Maccabi, over 20 years. The app questions the user based on previous answers. K contrasts it to static protocols, or rules-based symptom checking. The second is to provide a primary care visit via text for $19/visit (or unlimited for $39/year) with free follow-ups over two weeks. The third is mental health, specifically treatment for anxiety and depression, a growing area both online and via mobile. The $29/month fee covers unlimited doctor visits and delivered prescription medication, excepting meds that require blood testing.

The symptom checker is available throughout the US and primary care in 47 states. According to Crunchbase’s interview with CEO Allon Bloch, they recently passed their 3 millionth user and are now available in Spanish. The company has grown in the past year from 80 to 200 people. Originally, the company linked to New York-based providers, but moved away from that to the primary care/text model. Their overall goal is to provide affordable diagnoses that are a lot more accurate than ‘Dr. Google’ and that steer the patient to the right care.

Should Babylon Health be serious about expansion to the US, they will be running up against K Health, as well as competitors such as 98point6. In the hybrid app-and-physical model, there are Carbon Health and One Medical. Also Mobihealthnews

Last month, this Editor took note of the Twitterstorm around Babylon Health on the issues raised surrounding diagnosis of women’s cardiac symptoms. @DrMurphy11, who has been raising performance issues with the Babylon chatbot for the past three years, ran a test on the app. First using a male patient, then a woman, with identical cardiac symptoms, the app returned two different diagnoses: the man was advised to go to an ED on an emergency basis and given information on a heart attack, the woman to her GP in six hours and given information on a panic attack.

@DrMurphy11 came out earlier this week to BBC Two’s Newsnight’s Emma Barnett on a profile of ‘healthcare juggernaut’ Babylon as Dr. David Watkins, a consultant oncologist. You can see him on YouTube here (at the 1 minute and 3 min. 30 mark). He demonstrates the response of the chatbot, using as the patient an older male smoker with chest pains. The chatbot advises him that he might have either gastritis or ‘sickle cell crisis in chest’–and to go to his GP in 6 hours. What is far more likely than sickle cell with this history is, of course, a heart attack, as a consultant cardiologist, Dr. Amitava Banerjee confirmed on the program. Dr. Banerjee has also been critical of Babylon’s chatbot on cardiac diagnosis and Health Secretary Matt Hancock in his visible advocacy of Babylon in the NHS alone (at 6 min.) According to Dr. Watkins, he has been documenting chatbot problems to the MHRA and the CQC since 2017, and the problems haven’t been fixed.

Timed with the Newsnight piece, Babylon fired back with a press release labeling Dr. Watkins a “troll” and stating that only 100 of his 2,400 tests demonstrated any concerns with the chatbot. According to the release, Babylon’s staff “have attempted to start a positive conversation with this anonymous person. We have invited him in to start a dialogue, to test our AI, and to meet with the senior doctors who build our products” without response. Babylon has also cited that all of Dr. Watkins’ trials were theoretical tests and cites millions of real uses without a single report of harm, that it meets regulatory standards in five countries including use in the NHS, and that its real life users are highly satisfied (85 percent at 5 stars).

At 6:48 to 12:40 in the video, Newsnight’s Emily Maitlis grills both Babylon’s Dr. Keith Grimes and Dr. Watkins. She brings up that Babylon’s former head of regulatory affairs, Hugh Harvey, had stated that no one has assessed how well the app works. Dr. Watkins also counters Babylon’s non-contact claim that he contacted one of the Babylon leadership members back in 2018 on chatbot problems. Dr. Grimes responded to Ms. Maitlis’ remark that founder Ali Parsa is not a doctor that over 600 doctors work for Babylon. This Editor will leave it to Readers to decide what side won, or if it was a draw. Also Mobihealthnews global edition. (For US Readers, Newsnight and Ms. Maitlis conducted the exclusive, disastrous–for Prince Andrew–interview on his relationship with the late Jeffrey Epstein.)

HITLAB, which is a digital health research, teaching, and advisory services organization with the objective to improve healthcare delivery worldwide, is presenting a talk on digital health, eye care, and medication adherence. The featured speaker is Dr. Thomas Wong, an Associate Clinical Professor and Director of New Technologies at SUNY Optometry. Cost is $6.93 including Eventbrite’s take! Event information and tickets here.

Upcoming in HITLAB’s Seminar Series are When Patients Lose Patience: The Healthcare Consumer in 2020 (19 March) and The New Clinical Trial: Medication as a Core Business Strategy to Improved Drug Trials (23 April). Future events and notification signup here.

Speakers at this CBS conference will focus on the transformative impact New York City is having on the healthcare industry, and are from a cross-section of established healthcare organizations, emerging companies, and investment firms will present informed views. The Conference includes four panels, an inaugural CBS Start-up Showcase, and a Sponsor Expo. It also includes a buffet breakfast and lunch as well as a networking happy hour from 4:30 – 6:30 pm. Cost is $350, $200 for Columbia alumni, and only $75 for students. Conference information and tickets here.

This three-day intensive executive education course sponsored by Columbia Business School Executive Education and HITLAB is an industry-first program that distills how digital technologies can transform life science research, clinical development, patient experience, operations, and business models. Upon completing the program, participants will earn three days toward a certificate with select alumni and tuition benefits. Application and additional information here.

Mark your calendars for this three-day conference which will focus on the diffusion of digital technologies in the healthcare system, with speakers and attendees who are on the front lines of identifying, validating, integrating, and scaling emerging technologies that are improving patient outcomes. Preliminary conference information and 2019 information here.

Our definitions

Telehealth and Telecare Aware posts pointers to a broad range of news items. Authors of those items often use terms 'telecare' and telehealth' in inventive and idiosyncratic ways. Telecare Aware's editors can generally live with that variation. However, when we use these terms we usually mean:

• Telecare: from simple personal alarms (AKA pendant/panic/medical/social alarms, PERS, and so on) through to smart homes that focus on alerts for risk including, for example: falls; smoke; changes in daily activity patterns and 'wandering'. Telecare may also be used to confirm that someone is safe and to prompt them to take medication. The alert generates an appropriate response to the situation allowing someone to live more independently and confidently in their own home for longer.

• Telehealth: as in remote vital signs monitoring. Vital signs of patients with long term conditions are measured daily by devices at home and the data sent to a monitoring centre for response by a nurse or doctor if they fall outside predetermined norms. Telehealth has been shown to replace routine trips for check-ups; to speed interventions when health deteriorates, and to reduce stress by educating patients about their condition.

Telecare Aware's editors concentrate on what we perceive to be significant events and technological and other developments in telecare and telehealth. We make no apology for being independent and opinionated or for trying to be interesting rather than comprehensive.